Blade plate and instruments

ABSTRACT

A blade plate, as well as instruments and methods for securing the blade plate to a bone to reduce a bone fracture. The blade plate includes a plate portion and a blade portion extending at an angle relative to the plate portion. The plate portion includes a plurality of holes for receipt of bone screws for securing the blade plate to the bone about the bone fracture. A strut screw, inserted through a hole in the plate portion, spans the angle between the plate and blade portions, and threadingly engages a hole in the blade portion to slightly draw the plate and blade portions together to compress and support the bone fracture. A pair of top screws are inserted through holes in the plate portion at angles with respect to the strut screw on either side of the strut screw. Additionally, the blade plate is designed to closely conform to the surface of the bone to minimize the gap between the bone and the blade plate. In order to secure the blade plate to a bone, a chisel/drill guide, chisel, insertion guide, and screw drill guides are provided.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.09/939,412, entitled BLADE PLATE AND INSTRUMENTS, filed on Aug. 24,2001, assigned to the assignee of the present application, thedisclosure of which is expressly incorporated hereby by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to medical implants and associated methodsfor reducing a bone fracture and supporting the bone while the boneheals, and more particularly, to a blade plate and instruments forsecuring the blade plate to a bone to reduce a bone fracture.

2. Description of the Related Art

Bone plates are secured to a bone about a fracture in the bone to holdthe bone in place while the fracture heals. Additionally, the bone platemay be secured to the bone in a manner in which the bone plate alsoprovides support and/or compression to the bone about the fracture inorder to compress the fracture. Typically, such bone plates include aplurality of holes therein for receipt of screws which are inserted intothe bone to secure the bone plate to the bone about the fracture to holdthe fracture in place. The bone plate may also include a blade extendingtherefrom for insertion into a channel which has been pre-cut into thebone, in order to support the fragments of the fractured bone and toestablish a compressive load about the fracture to compress thefracture.

While known bone plates have proven effective for reducing a bonefracture and compressing the fracture while the bone heals, an improvedbone plate, as well as instruments for securing the bone plate to abone, are desired, for providing improved bone fixation about thefracture, increased patient comfort, and improved accuracy ofinstallation.

SUMMARY OF THE INVENTION

The present invention provides a bone plate, as well as instruments andmethods for securing the bone plate to a bone to reduce a bone fracture.The bone plate may be in the form of a blade plate, including a plateportion and a blade portion extending at an angle relative to the plateportion. The plate portion includes a plurality of holes for receipt ofbone screws for securing the blade plate to the bone about the bonefracture. A strut screw hole in the plate portion, which is disposed atan angle relative to the plane in which the plate portion is disposed,receives a strut screw therethrough. The strut screw spans the anglebetween the plate and blade portions, and the end of the strut screwthreadingly engages a hole in the blade portion to support the bladeportion and to prevent movement of same, and to secure the blade andplate portions of the blade plate about the fracture to compress thefracture.

Additionally, the plate portion includes first and second holes forreceiving top screws, the first and second holes including counterboreswhich are shaped to allow the top screws to be received therethrough atan angle relative to the strut screw to avoid contact between the topscrews and the strut screw. Further, the plate portion includes a crossscrew hole disposed closely adjacent the strut screw hole through whicha cross screw may be inserted, with the head of the cross screw abuttingthe head of the strut screw to lock the strut screw in position wherebywithdrawal of the strut screw outwardly from the bone is prevented.

The plate and blade portions are connected at a bend in the blade plate.The fillet radius of the bend, which is defined interiorly of the bendintermediate the plate and blade portions, is greatly reduced from knowndesigns, allowing closer conformity of the blade plate with the bonesurface at the outer edge of the channel in the bone through which theblade is inserted, and minimizing the gap between the blade plate andthe bone surface in the area of the bend in the blade plate.

To secure the blade plate to the bone about the fracture, instrumentsand corresponding methods are also disclosed. One embodiment of suchinstruments and corresponding methods is briefly described below. Achisel and drill guide assembly is provided, which includes achisel/drill guide member having at least one slot therein through whicha guide wire may be disposed for locating the chisel/drill guide memberwith respect to the bone surface, and a plate portion extendingtherefrom which rests against the bone surface. A drill guide, whichincludes drill guide holes for drilling holes in the bone whichcorrespond to the insertion point of the blade portion of the bladeplate, is received within a channel in the chisel/drill guide member.The drill guide is removed after such holes are drilled, and a chisel isinserted through the channel in the chisel/drill guide member and driveninto the bone to form a blade insertion channel in the bone about theholes. After the blade insertion channel is formed, the chisel isremoved, and a drill or saw blade is inserted into a chamfer slot in thechisel/drill guide member to remove bone material from a corner portionof the bone at the opening of the blade insertion channel, therebyforming a chamfer on the bone to facilitate a closely conforming fitbetween the fillet radius of the blade plate and the bone at the openingof the blade insertion channel.

After removal of the chisel/drill guide member, an insertion guide issecured to the blade plate and passed over the guide wire. A hammer andimpaction handle, or alternatively, a slap hammer, is used to drive theblade portion of the blade plate into the blade insertion channel in thebone. After insertion of the blade portion of the blade plate, screwsare inserted through the blade plate and into the bone to reduce andcompress the fracture. The number of screws inserted, and the order ofinsertion thereof, may vary. A top screw drill guide is attached to theinsertion guide to facilitate the insertion of a first top screw at anangle relative to the plate portion, after first pre-drilling a guidehole in the bone through the top screw drill guide. The top screw drillguide is then removed from the insertion guide. A strut screw drillguide is then attached to the insertion guide, and, after pre-drilling ahole in the bone, a strut screw is inserted which extends through thebone between the plate portion and the blade portion of the blade plate,the strut screw threadingly engaging the blade portion to secure theblade plate and plate portions about the fracture. An additional topscrew, a cross screw, and a plurality of compression screws may also beinserted through the plate portion of the blade plate as needed tofurther secure the blade plate to the bone for reducing the fracture.

In one form thereof, the present invention provides a bone plateassembly, including a bone plate including first and second extendingportions defining an angle therebetween, each of the first and secondportions having at least one hole therein; and a screw extending througha hole in one of the first and second portions, the screw threadinglyengaging another hole in the other of the first and second portions,wherein the screw spans said angle between the first and secondportions.

In another form thereof, the present invention provides a bone plate,including a plate portion and a blade portion extending from one anotherat an angle and connected to one another at a bend, the bend having aradius defined intermediate the plate portion and the blade portion, theradius dimensioned such that, with the plate portion resting against anouter surface of a bone and the blade portion extending into the bone,the radius fits closely adjacent the outside surface of the bone.

In another form thereof, the present invention provides a method ofdesigning a blade plate from at least one sample bone such that the boneplate conforms to the outer surface of the bone, including the steps oftaking a plurality of measurements of the bone surface; generating oneof a three-dimensional model and a three-dimensional map of the bonesurface; and determining the shape of the bone plate to conform to oneof the three-dimensional model and three dimensional map.

In another form thereof, the present invention provides a bone plate,including an elongate plate portion disposed in a plane, the plateportion including first and second holes disposed closely adjacent oneanother, the first hole disposed through the plate portion at an anglerelative to the plane and the second hole disposed through the plateportion substantially perpendicular to the plane; and first and secondscrews each having a head, the first and second screws respectivelydisposed through the first and second holes, the head of the secondscrew positioned to prevent removal of the first screw from the plateportion.

In another form thereof, the present invention provides a bone plateassembly, including a bone plate having elongate plate and bladeportions connected to one another at a bend and disposed at an anglewith respect to one another, the plate portion having a first holetherein and a second hole therein which is disposed intermediate thefirst hole and said bend; a strut screw disposed through the first holeand extending toward the blade portion; a top screw disposed through thesecond hole, the top screw extending angularly to one side of the strutscrew.

In another form thereof, the present invention provides a kit, includinga chisel having an elongate blade portion; and a chisel and drill guidemember, the chisel and drill guide member having a first channeltherethrough, the first channel dimensioned to receive the chisel.

In another form thereof, the present invention provides a kit, includinga drill guide insert; and a chisel and drill guide member, the chiseland drill guide member having a first channel therethrough, the firstchannel dimensioned to receive the drill guide insert.

In another form thereof, the present invention provides a method,including the steps of providing a chisel and a chisel guide member, thechisel guide member having a channel therethrough dimensioned to receivethe chisel, and a chamfer slot extending therethrough to meet thechannel, the chamfer slot disposed at an angle with respect to thechannel; locating the chisel guide member against the surface of a bone;inserting the chisel through the channel in the chisel guide member;driving the chisel into the bone to form an insertion channel through atleast a portion of the bone, the insertion channel defining an openingat the bone surface having a corner portion; providing a tool; insertingthe tool through the chamfer slot of the chisel guide member; andremoving bone material from the corner portion with the tool tosubstantially form a radius in the edge of the bone at the insertionchannel opening.

In a further form thereof, the present invention provides a kit,including a bone plate having elongate plate and blade portions disposedat an angle with respect to one another, the plate portion having aplurality of holes therein; an insertion guide member detachablysecurable to the plate portion of the bone plate; and a screw guidedetachably securable to the insertion guide member in alignment with oneof the plurality of holes in the plate portion.

In a still further form thereof, the present invention provides a kit,including a bone plate having plate and blade portions disposed at anangle with respect to one another, the plate portion having a longdimension and plurality of holes therein; and an insertion guide memberdetachably securable to the plate portion of the bone plate, theinsertion guide member having at least one screw guide member integraltherewith, the screw guide member disposed at an angle with respect tothe plate and blade portions.

BRIEF DESCRIPTION OF THE DRAWINGS

The above-mentioned and other features and advantages of this invention,and the manner of attaining them, will become more apparent and theinvention itself will be better understood by reference to the followingdescription of an embodiment of the invention taken in conjunction withthe accompanying drawings, wherein:

FIG. 1 is a partial sectional view through a bone having a fracture,including a known blade plate assembly secured to the bone;

FIG. 2 is a side view of a known blade plate;

FIG. 3 is a partial sectional view through a bone having a fracture,including a blade plate assembly according to the present inventionsecured to the bone;

FIG. 4 is a perspective view of a blade plate according to the presentinvention;

FIG. 5A is a side view of the blade plate of FIG. 4;

FIG. 5B is a side view of an alternative embodiment of the blade plateof FIGS. 4 and 5A;

FIG. 6 is a perspective view of a bone having a fracture, and a guidewire inserted into the bone;

FIG. 7 is a perspective view of a bone to which a chisel/drill guidemember is attached, further showing a drill guide insert being insertedwithin the guide channel of the chisel/drill guide member;

FIG. 8 is a perspective view of the drill guide insert of FIG. 7;

FIG. 9 is a perspective view of a bone to which a chisel/drill guidemember is attached, further showing a guide hole being drilled throughthe drill guide insert;

FIG. 10 is a perspective view of a chisel;

FIG. 11 is a perspective view of a bone to which a chisel/drill guidemember is attached, further showing the chisel of FIG. 10 being driveninto the guide channel of the chisel/drill guide member to form a bladeinsertion channel in the bone;

FIG. 12 is a sectional view of a bone to which a chisel/drill guidemember is attached, further showing a drill being inserted through thechamfer slot of the chisel/drill guide member to remove bone materialfrom a corner portion of the blade insertion channel in the bone;

FIG. 13 is an exploded view showing a bone having a blade insertionchannel formed therein, a blade plate, an insertion guide, and a screwand lock member for securing the insertion guide to the blade plate;

FIG. 14 is a sectional view of the screw and lock member of FIG. 13,taken along line 14-14 of FIG. 13;

FIG. 15 is a perspective view of a bone to which a blade plate andinsertion guide is attached, further showing an impaction handle fordriving the blade plate into the blade insertion channel in the bone;

FIG. 16 is a perspective view of a bone to which a blade plate andinsertion guide is attached, further showing a top screw drill guideattached to the insertion guide and a top screw drill sleeve beinginserted into the top screw drill guide;

FIG. 17 is a bottom view of insertion guide of FIG. 16, showing the topscrew drill guide attached thereto;

FIG. 18 is a sectional view taken along line 18-18 of FIG. 17;

FIG. 19 is a perspective view of a bone to which a blade plate andinsertion guide is attached, further showing a top screw hole beingpre-drilled into the bone through the top screw drill guide;

FIG. 20 is a perspective view of a bone to which a blade plate andinsertion guide is attached, further showing a top screw being insertedinto the bone through the top screw drill guide after removal of the topscrew drill sleeve;

FIG. 21 is a perspective view of a bone to which a blade plate andinsertion guide is attached, further showing removal of the top screwdrill guide, and a plurality of compression screws inserted through theblade plate into the bone;

FIG. 22 a is a perspective view of a bone to which a blade plate andinsertion guide is attached, further showing a strut screw drill guideattached to the insertion guide, and a strut screw drill sleeve beinginserted into the strut screw drill guide;

FIG. 22 b is a sectional view through the bone, blade plate, andinsertion guide of FIG. 22 a;

FIG. 23 is a perspective view of a bone to which a blade plate andinsertion guide is attached, further showing a strut screw hole beingpre-drilled into the bone through the strut screw drill guide;

FIG. 24 is a perspective view of a bone to which a blade plate andinsertion guide is attached, further showing a strut screw beinginserted into the bone through the strut screw drill guide;

FIG. 25 is a sectional view through a portion of the blade portion of ablade plate, showing a strut screw threadedly engaging a blade platehole in the blade portion of the blade plate;

FIG. 26 is a partial sectional view of a blade plate through which apair of top screws and a strut screw have been inserted, viewed directlydown the strut screw and showing the top screws each disposed at anangle with respect to the strut screw;

FIG. 27 is a sectional view through a blade plate, showing a cross screwinserted through the cross screw hole in the blade plate, the crossscrew being spaced from the head of the strut screw;

FIG. 28 is a sectional view through a blade plate, showing a cross screwinserted through the cross screw hole in the blade plate, the head ofthe cross screw abutting the head of the strut screw to lock the strutscrew in position;

FIG. 29 is a perspective view of a bone to which a blade plate isattached, further showing an insertion guide, top screw drill sleeve,and a thumb screw for securing the insertion guide to the blade plate,according to another embodiment of the present invention;

FIG. 30 is a perspective view of a bone to which a blade plate isattached, further showing an insertion guide according to a furtherembodiment of the present invention, and also showing a strut screwdrill guide and strut screw drill sleeve;

FIG. 31 is a perspective view of a bone to which a blade plate isattached, further showing the insertion guide of FIG. 30, and a strutscrew drill sleeve being inserted into the strut screw drill guide;

FIG. 32 is a perspective view of a bone to which a blade plate isattached, further showing removal of the insertion guide of FIG. 31, anda hand-held top screw drill guide inserted into one of the top screwholes in the blade plate; and

FIG. 33 is a partial perspective view of the hand-held top screw drillguide of FIG. 32.7

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate preferred embodiments of the invention, and suchexemplifications are not to be construed as limiting the scope of theinvention in any manner.

DETAILED DESCRIPTION

Referring to FIG. 1, a known bone plate assembly 40 is shown, includingbone plate 42 secured to bone 44 by screws 46 a-f, which are insertedthrough holes in bone plate 42 and into bone 44 about fracture 47 tohold the fragments of bone 44 in place until bone 44 heals. Bone plate42 is shown as a blade plate, including plate portion 48 having aplurality of holes therethrough for receipt of screws 46 a-f, and bladeportion 50 extending from plate portion 48 to define an angletherebetween. Plate portion 48 and blade portion 50 are connected atbend 52, which defines fillet radius 54 (FIG. 2) intermediate plateportion 48 and blade portion 50. Referring to FIG. 1, it may be seenthat, due to the large size of fillet radius 54, a large gap 56 existsbetween plate portion 48 and outer surface 58 of bone 44 adjacent bend52, wherein bend 52 projects outwardly of outer surface 58 of bone 44.Screws 46 a-f include strut screw 46 c, which is disposed through one ofthe holes in plate portion 48 and extends toward blade portion 50 ofblade plate 42 such that end 60 of strut screw 46 c abuts blade portion50.

Referring to FIG. 3, bone plate assembly 70 is shown in accordance withthe present invention, including bone plate 72, which is shown as ablade plate secured to bone 44 about fracture 47 to hold the fragmentsof bone 44 in place and to provide a compressive force about fracture47. Referring to FIGS. 3 and 4, blade plate 72 includes plate portion 74and blade portion 76 connected to one another at bend 75. Blade portion76 extends from plate portion 74 to define an angle therebetween which,as shown in FIGS. 3 and 4, is a slightly obtuse angle. However, bladeplate 72 may be shaped such that the angle defined between plate andblade portions 74, 76 may vary from slightly acute to significantlyobtuse, or any desired angle, depending on the particular geometry ofthe bone to which blade plate 72 is to be secured. Additionally,although blade plate 72 is shown in FIG. 3 secured to the proximalfemur, it should be understood that blade plate 72 may be appropriatelyshaped and dimensioned for securing same to the distal femur, or to anyother bone having a fracture therein, in order to reduce and compressthe fracture, without departing from the present invention.

Referring to FIG. 4, plate portion 74 includes first and second topscrew holes 82 a, 82 b, strut screw hole 84, cross screw hole 86, and aplurality of compression screw holes 88 a-c. As shown in FIG. 4, it maybe seen that the foregoing holes include respective bores disposedthrough plate portion 74, as well as generally bowl-shaped counterboresextending partially through the thickness of plate portion 74 whichdefine recesses 90 a-f in plate portion 74. Recesses 90 a-b of top screwholes 82 a, 82 b are shown as oval-shaped, with the long dimensionsthereof extending generally perpendicular to the long dimension of plateportion 74, and recess 90 c of strut screw and cross screw holes 84, 86,as well as recesses 90 d-f of compression screw holes 88 a-c are alsoshown as oval-shaped, with the long dimensions thereof extendinggenerally parallel to the long dimension of plate portion 74. Recess 90c encompasses both strut screw hole 84 and cross screw hole 86. Recess92 is defined in plate portion 74 intermediate first top screw hole 82 aand bend 75.

Blade portion 76 includes blade end 94 having a generally U-shaped crosssection including three blade edges 96. Alternatively, blade end 94 mayhave an inverted T-shaped cross section, or any other suitable crosssection. Blade portion 76 also includes blade hole 98 having a chamfertherearound which defines ledge 100 around at least a portion of bladehole 98.

Referring to FIGS. 5A and 5B, bend 75 of blade plate 72 includes filletradius 102 defined intermediate plate portion 74 and blade portion 76,wherein the size of fillet radius 102 is minimized in comparison withknown blade plate 42 of FIGS. 1 and 2. Specifically, the size of filletradius 102 of blade plate 72 is 0.25 inches or less, preferably 0.125inches, which is reduced from the fillet radius 54 of prior blade plate42 of FIGS. 1 and 2, which prior fillet radius is typicallyapproximately 0.375 inches. Therefore, referring to FIG. 3, when bladeplate 72 is secured to bone 44, the reduced size of fillet radius 102thereof reduces the gap 56 between plate portion 74 of blade plate 72and outer surface 58 of bone 44, allowing blade plate 72 to closelyconform with outer surface 58 of bone 44.

Referring to FIG. 5A, plate portion 74 may include first segment 78 andsecond segment 80, which meet at intersection 81, which defines an edgebetween first and second segments 78, 80. Alternatively, as shown in theembodiment of FIG. 5B, the interface between first and second segments78, 80 may be curved at 82 whereby intersection 81 is eliminated, suchthat plate portion 74 of blade plate 72 may conform even more closelywith the outer surface 58 of bone 44. Specifically, in the embodiment ofFIG. 5B, the interior profile 104 of plate portion 74 is shaped to matchthe outer surface 58 of a bone to which blade plate 72 is attached, suchas the proximal femur shown in FIG. 3. In order to determine theappropriate shape of interior profile 104 of plate portion 74, actualbone specimens may be used. For example, with regard to designing theshape of a blade plate for a proximal femur, a plurality of measurementsmay taken of the outer surface of proximal femur specimens, followed bygenerating one or more three-dimensional maps or models of the femursusing a computer, which maps or models are then used to design bladeplates having desired shape characteristics, such as the interiorprofile of plate portion 74 which conforms closely to the outer surfaceof the proximal femur. The foregoing design method may be used to designblade plates according to the present invention for use with any type ofbone to which a blade plate may be secured.

Exemplary methods of securing blade plate 72 to a bone to reduce afracture in the bone and to compress the fracture, and instrumentstherefor, will now be described with reference to FIGS. 6-32, in whichmethods are shown for securing blade plate 72 to a fractured proximalfemur. Initially, an incision (not shown) is made in the body, accordingto a suitable surgical procedure, to create a surgical wound near thefracture in the proximal femur to expose outer surface 58 of bone 44about fracture 47. As shown in FIG. 6, a Kirschner guide wire 106 isthen inserted into bone 44 in a known manner to provide a fixedreference point with respect to bone 44, wherein the free end of guidewire 106 extends outwardly of the wound in the patient.

A chisel/drill guide member 108, shown in FIG. 7, is used to locate andguide the procedure of forming a blade insertion channel 110 (FIG. 13)within bone 44. Chisel/drill guide member 108 includes head portion 112with plate portion 114 extending therefrom. Head portion 112 includes aplurality of guide wire holes 116 for insertion of guide wire 106therethrough to properly locate chisel/drill guide member 108 withrespect to bone 44. Guide channel 118 also extends through head portion112 of chisel/drill guide member 108, and includes first key element 120therein, which is shown in FIG. 7 as a shoulder extending into guidechannel 118. Chamfer slot 122 also extends through head portion 112, andis disposed at an angle with respect to guide channel 118, wherein thedistal ends of guide channel 118 and chamfer slot 122 meet one another,as shown in FIG. 12. Chisel/drill guide member 108 additionally includesattachment post 124 for attaching handle 126 thereto. Handle 126includes handle portion 128 for grasping, and quick-connect/disconnectcollar 130 for quick attachment and detachment of handle 126 to and fromattachment post 124 of chisel/drill guide member 108.

After attaching handle 126 to attachment post 124 of chisel/drill guidemember 108, the free end of guide wire 106 is inserted through one ofthe guide wire channels 116 in head portion 112 of chisel/drill guidemember 108. Chisel/drill guide member 108 is then located against outersurface 58 of bone 44 as shown in FIG. 7, wherein barbs 132 extendingfrom plate portion 114 of chisel/drill guide member may bear againstouter surface 58 of bone 44 to anchor chisel/drill guide member 108thereagainst. Plate portion 114 of chisel/drill guide member 108additionally includes a plurality of reference holes 134 therein toindicate the locations on outer surface 58 of bone 44 at which screwswill later extend into bone 44 through blade plate 72.

Referring still to FIG. 7, drill guide insert 136 (see also FIG. 8) isinserted within guide channel 118 of chisel/drill guide member 108.Drill guide insert 136 includes a second key element 138, shown in FIG.8, as a channel, which mates with first key element 120 of guide channel118 to ensure that drill guide insert 136 is inserted within guidechannel 118 according to a predetermined orientation. Head flange 140 ofdrill guide insert 136 abuts head portion 112 of chisel/drill guidemember 108 at the entrance of guide channel 118. Drill guide insert 136includes a plurality of bores 142 therein which serve as guides fordrilling a plurality of corresponding guide holes within bone 44.Referring to FIG. 9, after chisel/drill guide member 108 is positionedon bone 44 with drill guide insert 136 disposed in guide channel 118thereof, guide holes are drilled in bone 44 using a tool, such as drill135 with bit 137, through each of the bores 142 of drill guide insert136, which correspond to the location of blade insertion channel 110within bone 44. After such holes are drilled, drill guide insert 136 isremoved from guide channel 118 of chisel/drill guide member 108.

Chisel 142, shown in FIGS. 10 and 11, includes stem portion 144 havingblade 146 at one end, and head 148 at the other end thereof oppositeblade 146. Stem portion 144 of chisel 142 includes a second key element138, shown as a channel, which is adapted to mate with first key element120 within guide channel 118 of chisel/drill guide member 108 when blade146 and stem portion 144 of chisel 142 are inserted therethrough. Theengagement between first key element 120 of guide channel 118 and secondkey elements 138 of either drill guide insert 136 or chisel 142,respectively, insures that drill guide insert 136 and chisel 142 areeach inserted into guide channel 118 according only to a desiredorientation, thereby preventing drill guide insert 136 and chisel 142from being inserted upside down, for example, within guide channel 118.Alternatively, guide channel 118 and each of drill guide insert 136 andchisel 142 may be otherwise cooperatively shaped or dimensioned suchthat drill guide insert 136 and chisel 142 may be inserted into guidechannel 118 only according to a single, desired orientation. Forexample, guide channel 118 may define a hemispherical opening, and drillguide insert 136 and chisel 142 may have cooperating hemisphericalprofiles.

After chisel 142 is inserted through guide channel 118 in chisel/drillguide member 108 as shown in FIG. 11, head 148 of chisel 142 is impactedwith a hammer, mallet, or slap hammer to drive blade 146 of chisel 142into bone 44 to form blade insertion channel 110 within bone 44. Chisel142 may additionally include depth markings 150 thereon, shown in FIG.10, which correspond to the depth into bone 44 to which blade 144 shouldbe driven in order to result in a desired depth of blade insertionchannel 110. Additionally, as shown in FIG. 11, head 148 of chisel 142includes a flattened, cut-away portion at 152, which is faces guide wire106 in order to prevent potentially interfering contact between head 148of chisel 142 and guide wire 106 as chisel in driven into bone 44. Afterchisel 142 is driven into bone 44 to form blade insertion channel to adesired depth, chisel 142 is removed from guide channel 118 ofchisel/drill guide member 108 to allow access to blade insertion channel110 in bone 44.

Referring to FIG. 12, blade insertion channel 110 includes opening 154at outer surface 58 of bone 44, which opening 154 includes cornerportion 156. A suitable tool, such as drill 135 with bit 137, forexample, is inserted through chamfer slot 122 in head portion 112 ofchisel/drill guide member 108, and is driven against corner portion 156of opening 154 of blade insertion channel 110 to remove bone materialfrom corner portion 156 and thereby provide opening 154 of bladeinsertion channel 110 with a flattened, chamfered edge 158. Chamferededge 158 allows fillet radius 102 at bend 75 in blade plate 72 (shown inFIGS. 5A and 5B) to fit closely adjacent chamfered edge 158 of bone 44adjacent opening 154 of blade insertion channel 110 in bone 44. Afterbone material from corner portion 156 is removed as discussed above, thetool is removed, and then chisel/drill guide member 108 is removed frombone 44 and detached from the free end of guide wire 106.

After blade insertion channel 110 is formed in bone 44 as shown in FIG.13, blade plate 72 is secured to bone 44 as shown in FIGS. 13-32.Referring first to FIG. 13, insertion guide 160, according to oneembodiment of the present invention, is secured to blade plate 72 byscrew and lock member 162 (FIG. 14), which includes thumb screw 164 andlock member 166. As shown in FIG. 13, locking fingers 168 of lock member166 are inserted through second drill guide hole 176 of insertion guide160, and extend into top screw hole 82 b in blade plate 172. Uponthreading thumb screw 164 through lock member 166, locking fingers 168are spread apart to frictionally engage top screw hole 82 b to secureinsertion guide 160 to blade plate 72.

Insertion guide 160 generally includes head portion 170 having aplurality of holes 180 therein through which guide wire 106 may beinserted, and also includes impaction recess 178. Plate portion 172,extending from head portion 170, includes first and second drill guideholes 174, 176, as well as strut screw drill guide attachment hole 182.Optionally, head portion 172 of insertion guide 160 may include a stud(not shown) which may fit within recess 92 (FIG. 4) of blade plate 72 toaid in locating insertion guide 160 onto blade plate 72.

Referring to FIGS. 13 and 15, after insertion guide 160 is attached toblade plate 72, guide wire 106 is inserted through one of holes 180 inhead portion 170 of insertion guide 160, and blade end 94 of blade plate72 is aligned with blade insertion channel 110 in bone 144. Thereafter,impaction handle 184 is inserted into impaction recess 178, and head 186of impaction handle 184 is struck by a hammer or mallet to drive bladeportion 76 of blade plate 72 into blade insertion channel 110 of bone44. Alternatively, a slap hammer (not shown) may be used to drive bladeportion 76 of blade plate 72 into blade insertion channel 110 of bone44.

Referring to FIGS. 16-18, top screw drill guide 188 is attached toinsertion guide 160 with handle 190. Handle 190 includes handle portion192 and threaded end 194. As shown in FIGS. 16-17, threaded end 194 ofhandle 190 is inserted through handle guide cylinder 196 of top screwdrill guide 188. Threaded end 194 of handle 190 engages one of theindentations 198 formed in plate portion 172 of insertion guide 160 oneither side of first and second drill holes 174, 176, and additionally,flange 200 of top screw drill guide abuts an opposite side of plateportion 172 of insertion guide 160 to secure top screw drill guide 188to insertion guide 160.

Top screw drill guide 188 additionally includes top screw guide cylinder202 which, as shown in FIG. 16, is disposed at an angle with respect tothe long dimension of blade portion 76, and is also disposedsubstantially perpendicular to the long dimension of plate portion 74 ofblade plate 72, when top screw drill guide 188 is attached to insertionguide 160. Top screw drill sleeve 204 is threadingly inserted into topscrew guide cylinder 202 as shown in FIGS. 16 and 18, and, as shown inFIG. 19, drill 135 with bit 137 is used to drill a guide hole throughtop screw drill sleeve 204 into bone 44, which hole is disposed at anangle with respect to the long dimension of blade portion 76, and isdisposed substantially perpendicular to the long dimension of plateportion 74 of blade plate 72.

After such guide hole is drilled, top screw drill sleeve 204 is removedfrom top screw guide cylinder 202 as shown in FIG. 20, and a suitabletool, such as screwdriver 139, is used to insert top screw 206 a throughtop screw guide cylinder 202, top screw hole 82 a of blade plate 72(FIG. 4), and into the pre-drilled guide hole in bone 44. The foregoingprocedure is used when top screw 206 a is a self tapping screw.Alternatively, if a non-self tapping top screw is used, a tap sleeve(not shown) may be inserted into top screw guide cylinder 202, and abone tap (not shown) may be used to pre-tap the guide hole in the bonefor later insertion of a non-self tapping top screw.

Referring to FIG. 21, after top screw 206 a is inserted through topscrew hole 82 a of blade plate 72 and into bone 44, top screw drillguide 188 may be detached from insertion guide 160 by rotating handle190 to disengage threaded end 194 of handle 190 from indentation 198 ofinsertion guide 160.

Still referring to FIG. 21, after blade plate 72 has been initiallysecured to bone 44 by top screw 206 a, compression screws 208 a-c may beinserted into bone 44 in a suitable manner through compression screwholes 88 a-c of blade plate 72 to further secure blade plate 72 to bone44 and to compress bone 44 about fracture 47 to reduce fracture 47.However, it should be noted that compression screws 208 a-c may beinserted into bone 44 through compression screw holes 88 a-c in bladeplate 72 at any other suitable or desired time during the proceduredescribed herein.

Referring now to FIG. 22 a, strut screw drill guide 210 is attached tostrut screw drill screw guide attachment hole 182 (FIG. 13) of insertionguide 160 by thumb screw 212, and includes strut screw guide cylinder214 which is disposed at an acute angle with respect to blade plate 72when strut screw drill guide 210 is attached to insertion guide 160.Strut screw drill guide 210 may slide slightly along insertion guide 160in directions parallel to the long dimension of plate portion 74 ofblade plate 72, as indicated by the arrows in FIG. 22, to orient strutscrew drill guide 210 with strut screw hole 84 of blade plate 72. Strutscrew drill sleeve 216 is inserted into strut screw guide cylinder 214as shown in FIG. 22 a, and, as shown in FIG. 23, drill 135 with bit 137is used to drill a guide hole through strut screw drill sleeve 216,strut screw hole 84 in blade plate 72 (FIG. 4), and bone 44 toward bladehole 98 in blade portion 76 of blade plate 72.

Referring to FIG. 22 b, it may be seen that strut screw drill sleeve 216includes a reduced diameter, angled end 211 which extends through strutscrew hole 84 of blade plate 72. Angled end 211 is angled to restagainst outer surface 58 of bone 44 to guide bit 137 of drill 135 (FIG.23), such that skiving of bit 137 of drill 135 against outer surface 58of bone 44 is prevented when the strut screw guide hole is drilled intobone 44, as described above. Additionally, strut screw drill sleeve 216may include a pair of flexible cylinder sub-portions 213, one of sameincluding stud 215 which releaseably engages recess 217 in strut screwguide cylinder 214 when strut screw drill sleeve 216 is insertedtherein, in order to detachably lock strut screw drill sleeve 216 withinstrut screw guide cylinder 214.

Referring to FIG. 24, after removal of strut screw drill sleeve 216,strut screw 218 is inserted through strut screw guide cylinder 214 ofstrut screw drill guide 210, and through strut screw hole 84 (FIG. 4) ofblade plate 72 into bone 44. The foregoing procedure is used when strutscrew 218 is a self tapping screw. Alternatively, if a non-self tappingstrut screw is used, a tap sleeve (not shown) may be inserted into strutscrew guide cylinder 214, and a bone tap (not shown) may be used topre-tap the hole in the bone for later insertion of a non-self tappingstrut screw.

Additionally, as shown in FIG. 25, threads 220 of strut screw 218 engageledge 100 of blade hole 98 in blade portion 76 of blade plate 72 tothereby threadingly engage strut screw 218 with blade portion 76 ofblade plate 72. Blade portion 76 of blade plate 72 may thus be drawnslightly toward plate portion 74 of blade plate 72 by tightening strutscrew 218 in order to compress bone 44 about fracture 47 and support thefragments of bone 44. Additionally, strut screw 218 supports bladeportion 76 and prevents movement of blade portion angularly with respectto plate portion 74, and also torsionally about the long axis of bladeportion 76. After strut screw 218 is thus inserted through strut screwhole 84 of blade plate 72 through bone 44 and into blade hole 98 inblade portion 76 of blade plate 72, strut screw drill guide 210 isdetached from insertion guide 160 by loosening thumb screw 212.Optionally, after the strut screw guide hole is drilled into bone 44,strut screw drill guide 210 may be detached from insertion guide 160, asdescribed above, before strut screw 218 is inserted through strut screwhole 84 of blade plate 72 through bone 44.

A second top screw 206 b (FIG. 26) may be inserted through top screwhole 82 b of blade plate 72 into bone 44 after detaching screw and lockmember 162 from second drill hole 176 (FIG. 13) of insertion guide 160.Thereafter, top screw drill guide 188 may be attached to insertion guide160 as described above adjacent second drill guide hole 176, and asecond top screw 206 b may be inserted through top screw drill hole 82 binto bone 44 according to the procedure described above with regard totop screw 206 a. Optionally, after removal of insertion guide 160, aseparate hand-held top screw drill guide 248, such as that shown in FIG.30, may be used for insertion of a second top screw 206 b through topscrew hole 82 b of blade plate 72 into bone 44.

As shown in FIG. 26, top screw holes 82 a, 82 b of blade plate 72include second counterbores 222 a, 222 b extending partially through thethickness of plate portion 74 opposite first counterbores 90 a, 90 b(FIG. 4), which allow top screws 206 a, 206 b to be inserted through topscrew holes 82 a, 82 b at an angle with respect to the long dimension ofblade portion 76, and substantially perpendicular to the long dimensionof plate portion 74, of blade plate 72. In this manner, as shown in FIG.26, strut screw 218 may extend between top screws 206 a, 206 b, with topscrews 206 a, 206 b disposed at an angle with respect to strut screw218.

Referring to FIG. 27, cross or lock screw 224 may be inserted throughcross screw hole 86 into bone 44 in a suitable manner, such that head226 of cross screw 224 is spaced from head 228 of strut screw 218wherein head 226 of cross screw 224 still prevents removal of strutscrew 218 from bone 44. Alternatively, as shown in FIG. 28, and due tothe increased size of cross screw hole 86, cross screw 224 may beinserted through cross screw hole 86 into bone 44 such that head 226 ofcross screw 224 abuts head 228 of strut screw 218, wherein heads 226,228 of cross screw 224 and strut screw 218, respectively, are each atleast partially disposed within recess 90 c. In this manner, theabutment between heads 226, 228 of cross screw 224 and strut screw 218,respectively, locks strut screw 218 in position and prevents anywithdrawal of strut screw 218 outwardly of plate portion 74 of bladeplate 72.

With respect to the above-described procedure for securing blade plate72 to bone 44 about fracture 47, it should be understood that the orderof the particular steps thereof may be modified as desired, dependingupon the particular bone to which blade plate 72 is attached, thelocation and orientation of fracture 47 in bone 44, and other factors.

Referring to FIG. 29, a second embodiment of an insertion guide isshown. Insertion guide 230 a includes plate portion 232 with holes 231for receipt of guide wire 106 (not shown) therethrough, and impactionrecess 233. Plate portion 232 additionally includes integral top screwdrill guide 234, including a pair of top screw guide cylinders 236 whichare each disposed at an angle with respect to the long dimensions ofblade portion 76 of blade plate 72, as well as plate portion 232 ofinsertion guide 230 a. Top screw guide cylinders 236 additionallyinclude threads 238 for positively securing top screw drill sleeves 240therewithin, wherein threads 241 of top screw drill sleeves 240 engagethreads 238 of top screw guide cylinder 236. Insertion guide 230 aadditionally includes attachment hole 243 for receipt of thumb screw 242for attaching insertion guide 230 a to blade plate 72, wherein top screwhole 82 b of blade plate 72 may include threads 244 for engagement withthe threads of thumb screw 242. Additionally, strut screw drill guide210 (FIGS. 22 a-24) may be attached to strut screw drill guide hole 246provided in plate portion 232 of insertion guide 230 a, for drilling astrut screw guide hole in bone 44 and for inserting strut screw 218through blade plate 72 and into bone 44, also as described above.Insertion guide 230 a is otherwise used in a similar manner as insertionguide 160, described above, to secure blade plate 72 to bone 44.

Referring to FIGS. 30 and 31, a third embodiment of an insertion guideis shown. Insertion guide 230 b is similar to insertion guide 230 a,described above, and is used in a similar manner, except as describedbelow. Insertion guide 230 b lacks strut screw drill guide hole 246 ofinsertion guide 230 a, but rather includes strut screw drill guide post250 extending angularly from plate portion 232 of insertion guide 230 b.Strut screw drill guide 252 fits onto strut screw drill guide post 250for guiding the insertion of strut screw 218 through blade plate 72 intobone 44. Strut screw drill guide 252 includes housing 254 with bore 256therein, into which strut screw drill guide post 250 of insertion guide230 b extends, and also includes strut screw guide bore 258. Handle 260extends from housing 254 for grasping and manipulating strut screw drillguide 252.

Referring additionally to FIG. 31, strut screw drill sleeve 262 may beinserted into strut screw guide bore 258, and is used as a guide forpre-drilling a strut screw guide hole into bone 44, as described abovein connection with the foregoing embodiments. Strut screw drill sleeve262 includes angled end 264 which contacts outer surface 58 of bone 44to prevent skiving of the drill bit relative to outer surface 58 of bone44. Additionally, strut screw drill sleeve 262 includes flat 266 whichabuts face 268 of housing 254 of strut screw drill guide 252, such thatstrut screw drill sleeve 262 may only be inserted through strut screwguide bore 258 in an orientation in which angled end 264 rests againstouter surface 58 of bone 44. As also described above in connection withthe foregoing embodiments, strut screw drill sleeve 262 is removed afterthe strut screw guide hole is drilled in bone 44 to allow insertion of aself-tapping strut screw 218 into bone 44 through blade plate 72.Alternatively, a tap (not shown) may be inserted through strut screwguide bore 258 into the strut screw guide hole in bone 44, followed byinsertion of a non-self tapping strut screw into bone 44 through bladeplate 72.

As shown in FIGS. 32 and 33, after removal of insertion guide 230 b fromblade plate 72 following insertion of one of top screws 206 a, 206 b(not shown), according to the procedure described above in connectionwith the foregoing embodiment, a separate hand-held top screw drillguide 248 may be used to drill a guide hole into bone 44 for a secondtop screw 206 a, 206 b, and for guiding insertion of the second topscrew 206 a, 206 b through blade plate 72 and into bone 44. Hand-heldtop screw drill guide 248 includes handle 249, drill guide bore 253, andshaped head 251 dimensioned for close fitting within top screw holes 82a, b of blade plate 72.

While this invention has been described as having preferred designs, thepresent invention can be further modified within the spirit and scope ofthis disclosure. This application is therefore intended to cover anyvariations, uses, or adaptations of the invention using its generalprinciples. Further, this application is intended to cover suchdepartures from the present disclosure as come within known or customarypractice in the art to which this invention pertains and which fallwithin the limits of the appended claims.

1. A kit, comprising: a chisel having an elongate blade portion; and achisel and drill guide member, the chisel and drill guide member havinga first channel therethrough, said first channel dimensioned to receivesaid chisel.
 2. The kit of claim 1, wherein said first channel includesa first key element and said chisel includes a second key element, saidfirst and said second key elements engaging one another when said chiselis received within said first channel.
 3. The kit of claim 1, whereinsaid channel and said chisel are cooperatively dimensioned such thatsaid chisel may only be received through said channel according to asingle orientation.
 4. The kit of claim 1, wherein said chisel and drillguide member further includes a chamfer slot therein, said chamfer slotdisposed at an angle relative to said first channel and extendingthrough said chisel and drill guide member to meet said first channel.5. The kit of claim 1, wherein said chisel and drill guide memberfurther includes at least one second channel therethrough and disposedparallel to said first channel, said kit further including a guide wiredisposed through one of said at least one second channels.
 6. A kit,comprising: a drill guide insert; and a chisel and drill guide member,the chisel and drill guide member having a first channel therethrough,said first channel dimensioned to receive said drill guide insert. 7.The kit of claim 6, wherein said first channel includes a first keyelement and said drill guide insert includes a second key element, saidfirst and said second key elements engaging one another when said drillguide insert is received within said first channel.
 8. The kit of claim6, wherein said channel and said chisel are cooperatively dimensionedsuch that said chisel may only be received through said channelaccording to a single orientation.
 9. The kit of claim 6, wherein saiddrill guide insert includes a plurality of guide bores therein.
 10. Thekit of claim 6, wherein said chisel and drill guide member furtherincludes a chamfer slot therein, said chamfer slot disposed at an anglerelative to said first channel and extending through said chisel anddrill guide member to meet said first channel.
 11. The kit of claim 6,wherein said chisel and drill guide member further includes at least onesecond channel therethrough and disposed parallel to said first channel,said kit further including a guide wire disposed through one of said atleast one second channels.
 12. A method, comprising: providing a chiseland a chisel guide member, the chisel guide member having a channeltherethrough dimensioned to receive the chisel, and a chamfer slotextending therethrough to meet the channel, the chamfer slot disposed atan angle with respect to the channel; locating the chisel guide memberagainst the surface of a bone; inserting the chisel through the channelin the chisel guide member; driving the chisel into the bone to form aninsertion channel through at least a portion of the bone, the insertionchannel defining an opening at the bone surface having a corner portion;providing a tool; inserting the tool through the chamfer slot of thechisel guide member; and removing bone material from the corner portionwith the tool to substantially form a chamfer in the edge of the bone atthe insertion channel opening.
 13. The method of claim 12, furtherincluding, before said inserting step, the additional steps of:providing a drill guide insert having a plurality of bores therein;inserting the drill guide insert within the channel; drilling holes intothe bone through each of the drill guide holes; and removing the drillguide insert from the channel.